Publications by authors named "Jean-François Pelletier"

38 Publications

Assessing and promoting partnership between patients and health-care professionals: Co-construction of the CADICEE tool for patients and their relatives.

Health Expect 2021 May 5. Epub 2021 May 5.

Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada.

Context: Partnership between patients and health-care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs.

Objective: To co-construct a tool for measuring the degree of partnership between patients and HCPs.

Design: The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co-construct the tool; (3) assess face and content validity from patients' and HCPs' viewpoints; and (4) assess the usability of the tool and explore its measurement performance.

Results: The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise. Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity.

Conclusions: The CADICEE tool is developed in co-construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health-care settings.

Patient Or Public Contribution: Patients were involved in determining the importance of constructing this questionnaire. They co-constructed it, pre-tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.
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http://dx.doi.org/10.1111/hex.13253DOI Listing
May 2021

Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study.

JMIR Res Protoc 2020 Dec 18;9(12):e22500. Epub 2020 Dec 18.

Kowloon Hospital, Hong Kong, China.

Background: In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated.

Objective: This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting.

Methods: PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups-patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)-compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test.

Results: This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020.

Conclusions: Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study.

Trial Registration: ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324.

International Registered Report Identifier (irrid): PRR1-10.2196/22500.
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http://dx.doi.org/10.2196/22500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752185PMC
December 2020

Convergent and Concurrent Validity between Clinical Recovery and Personal-Civic Recovery in Mental Health.

J Pers Med 2020 Oct 12;10(4). Epub 2020 Oct 12.

Yale Program for Recovery & Community Health, Erector Square, Building 1, 319 Peck Street, New Haven, CT 06513, USA.

Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess convergent-concurrent validity between clinical recovery, citizenship and personal recovery. Recovery-oriented mental health care and services are particularly recognizable by the presence of Peer Support Workers, who are persons with lived experience of recovery. Upon training, they can personify personalized mental health care and services, that is to say services that are centered on the person's recovery project and not only on their symptoms. Data from our overall research strategy will lay the ground for the evaluation of the effects of the intervention of Peer Support Workers on clinical recovery, citizenship and personal recovery.
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http://dx.doi.org/10.3390/jpm10040163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712080PMC
October 2020

How service users and carers understand, perceive, rephrase, and communicate about "depressive episode" and "schizophrenia" diagnoses: an international participatory research.

Soc Psychiatry Psychiatr Epidemiol 2020 Sep 22;55(9):1201-1213. Epub 2020 Feb 22.

Association for Regional Development and Mental Health (EPAPSY), Athens, Greece.

Background: For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process.

Aims: The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences.

Method: An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication.

Results: Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of "depressive episode" mostly came from the concept itself, that of "schizophrenia" was largely based on its social impact and stigmatization associated with "mental illness". When rephrasing "depressive episode", a majority kept the root "depress*", and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on "schizophrenia". Finally, when communicating, no one used the phrase "depressive episode". Some participants used words based on "depress", but no one mentioned "episode". Very few used "schizophrenia".

Conclusion: Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.
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http://dx.doi.org/10.1007/s00127-020-01836-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471108PMC
September 2020

Recovery Mentors as continuing professional development trainers for better recognition of the epistemic value of the experiential knowledge and improved access to recovery-oriented practices.

AIMS Public Health 2019 25;6(4):447-460. Epub 2019 Oct 25.

Research Centre of Montreal Mental Health University Institute, Montreal East Island Integrated University Health and Social Services Centre, Montreal QC, Canada.

Objectives: To lay the groundwork for the arrival of Recovery Mentors (RMs) in some of its multidisciplinary teams, a Continuing Professional Development (CPD) conference was organized in a large public agency in the province of Quebec, Canada. The aim was to come up collectively with recommendations to improve access to recovery-oriented care and services for this vulnerable population by recognizing the epistemic value of their lived experience.

Methods: A series of workshops were organized among health professionals to reflect on their practice and to discuss the role of RMs for improving epistemic equity and recognition of the experiential knowledge. In preparation for these workshops participants completed the Recovery Self-Assessment (RSA). The RSA is a 32-item questionnaire designed to gauge the degree to which programs implement recovery-oriented practices, which should notably include RMs in multidisciplinary teams (five-point Likert scale: 1= ; 5 = ). The interactive workshops were hosted by RMs as trainers who first shared their lived experience and understanding of recovery.

Results: Eighty-height of the 105 participants completed the RSA. The highest score on the RSA was for the item (mean = 4.2/5). The lowest score was for the item (mean = 2.2/5). Based on the average inter-item correlation, a reliability test confirmed an excellent internal consistency for the French RSA scale, with a Cronbach's Alpha of .9. Means and standard deviation for each item of the RSA questionnaires were calculated. The results did not differ by participant characteristics. Results to the RSA and results from the workshops that were co-hosted by RMs were reported in the plenary session and further discussed. The workshops, the RSA and the whole CPD conference raised awareness among health professionals about stigmatizing attitudes and epistemic inequity in actual service provision.

Conclusion: RMs could be invited to actively participate and attend advisory boards and management meetings more frequently and on a more regular basis for ongoing quality improvement towards better access to recovery-oriented practices. This CPD conference has shown the acceptability and feasibility of including RMs as trainers for better recognition of the epistemic value of the experiential knowledge of recovery. They can help health professionals to recognize and better appreciate service users as knowers and potential contributors to knowledge.
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http://dx.doi.org/10.3934/publichealth.2019.4.447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940576PMC
October 2019

Coping Strategies for Oral Health Problems by People with Schizophrenia.

Transl Neurosci 2019 7;10:187-194. Epub 2019 Aug 7.

Clinical research unit, La Chartreuse psychiatric center, Dijon, France.

Background: Persons with schizophrenia are particularity susceptible to poor oral health. Symptoms of schizophrenia often affect oral health behaviors and lifestyle. The aim was to explore coping strategies used by people with schizophrenia in oral health in order to understand and to best involve them in the management of their own oral health in daily life.

Materials And Methods: This is systematic review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. We included cross-sectional and longitudinal quantitative and qualitative studies that 1) examined coping strategies regarding oral health in persons with schizophrenia or 2) examined coping strategies were used in dental care. We included studies conducted with at least one PWS aged 18 years old more and without restriction on sex, socioeconomic status, or language.

Results: The 8 studies included suggest that coping strategies depends on complex translation processes that can be either personal (e.g., psychological symptomatology, neuropsychological functioning to adversely affect hope, self-esteem, self-stigma, self-determination, sense of coherence, and resilience) and/or environmental factors (e.g., peer support and efficacy of rehabilitations programs). We further identified that the main factor influencing coping strategies was dental stress situation.

Conclusions: This review suggests that coping strategies play a crucial role in the recovery process for oral health of PWS. Translation processes in oral health should be more explored in the future to clarify the capacity of PWS to cope with essential self-care in oral health on daily life.
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http://dx.doi.org/10.1515/tnsci-2019-0033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689214PMC
August 2019

Omega-3 Fatty Acids Survey in Men under Active Surveillance for Prostate Cancer: from Intake to Prostate Tissue Level.

Nutrients 2019 Jul 16;11(7). Epub 2019 Jul 16.

Oncology Axis, Centre de recherche du CHU de Québec - Université Laval, QC G1R 3S1, Canada.

Dietary omega-3 fatty acids (ω3), particularly long-chain ω3 (LCω3), have protective effects against prostate cancer (PCa) in experimental studies. Observational studies are conflicting, possibly because of the biomarker used. This study aimed at evaluating associations between grade reclassification and ω3 levels assessed in prostatic tissue, red blood cells (RBC), and diet. We conducted a validation cross-sectional study nested within a phase II clinical trial. We identified 157 men diagnosed with low-risk PCa who underwent a first active surveillance repeat prostate biopsy session. Fatty acid (FA) intake was assessed using a food frequency questionnaire and their levels measured in prostate tissue and RBC. Associations were evaluated using logistic regression. At first repeat biopsy session, 39 (25%) men had high-grade PCa (grade group ≥2). We found that high LCω3-eicosapentaenoic acid (EPA) level in prostate tissue (odds ratio (OR) 0.25; 95% (confidence interval (CI) 0.08-0.79; -trend = 0.03) was associated with lower odds of high-grade PCa. Similar results were observed for LCω3 dietary intake (OR 0.30; 95% CI 0.11-0.83; -trend = 0.02) but no association for RBC. LCω3-EPA levels in the target prostate tissue are inversely associated with high-grade PCa in men with low-risk PCa, supporting that prostate tissue FA, but not RBC FA, is a reliable biomarker of PCa risk.
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http://dx.doi.org/10.3390/nu11071616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683032PMC
July 2019

The transcendent voice of recovery mentors in mental health: a philosophical reflection.

AIMS Public Health 2019 15;6(2):135-142. Epub 2019 Apr 15.

Department of Psychiatry and Addictology, University of Montreal, Canada.

In a globalized world health and illness know no frontiers. Pandemics have never been limited to political borders and the contemporary campaigns to prevent them can be effective only when addressed not only internationally but also with the application of integrated disease management in order to respond to problems caused by the silo approach. In any case, it appears that global health has been constantly in redefinition. With this commentary a phenomenological redefinition of global health is proposed as an integrative strategy. Phenomenology prioritizes and investigates from the first-person point of view how the human being experiences the world, as it explores the unique meaning of the lived experience of being human. We are particularly interested in verifying if and how, from a first-person point of view, the lived experience of mental illness and of recovery can contribute to a more integrated definition of global health. In the field of mental health, formal peer support is a mentor/mentee relationship, and as such it is an emotional and practical support between two people who share a common experience of a mental health challenge or illness. Peer support is a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. It is about understanding another's situation empathically through the shared experience of emotional and psychological pain. And when speaking in public, a recovery mentor accepts to disclose and to be recognized as a (former) mental health service user. That person knows that there is a possibility of being stigmatized, but yet remains courageously engaged towards the promotion of change and in solidarity with people who are suffering worldwide and who may not have this opportunity to speak freely.
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http://dx.doi.org/10.3934/publichealth.2019.2.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606531PMC
April 2019

A systematic mixed studies review on Organizational Participatory Research: towards operational guidance.

BMC Health Serv Res 2018 Dec 22;18(1):992. Epub 2018 Dec 22.

CIET/Participatory Research at McGill (PRAM), 5858 Cote de Neiges, 3rd floor, Montreal, Montreal, QC, H3S 1Z1, Canada.

Background: Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR processes and outcomes, but the link between these processes and outcomes is unknown. We sought to identify and sequence the key processes of OPR taking place with and within healthcare organizations and the main outcomes to which they contribute, and to define ideal-types of OPR.

Methods: This article reports a participatory systematic mixed studies review with qualitative synthesis A specialized health librarian searched MEDLINE, CINAHL, Embase Classic + Embase, PsycINFO, the Cochrane Library, Social Work Abstracts and Business Source Complete, together with grey literature data bases were searched from inception to November 29, 2012. This search was updated using forward citation tracking up to June 2014. Reporting quality was appraised and unclear articles were excluded. Included studies clearly reported OPR where the main research related decisions were co-constructed among the academic and healthcare organization partners. Included studies were distilled into summaries of their OPR processes and outcomes, which were subsequently analysed using deductive and inductive thematic analysis. All summaries were analysed; that is, data analysis continued beyond saturation.

Results: Eighty-three studies were included from the 8873 records retrieved. Eight key OPR processes were identified. Four follow the phases of research: 1) form a work group and hold meetings, 2) collectively determine research objectives, 3) collectively analyse data, and 4) collectively interpret results and decide how to use them. Four are present throughout OPR: 1) communication, 2) relationships; 3) commitment; 4) collective reflection. These processes contribute to extra benefits at the individual and organizational levels. Four ideal-types of OPR were defined. Basic OPR consists of OPR processes leading to achieving the study objectives. This ideal-type and may be combined with any of the following three ideal-types: OPR resulting in random additional benefits for the individuals or organization involved, OPR spreading to other sectors of the organization and beyond, or OPR leading to subsequent initiatives. These results are illustrated with a novel conceptual model.

Conclusion: The model provides operational guidance to help OPR stakeholders collaboratively address organizational issues and achieve desired outcomes and more.

Review Registration: As per PROSPERO inclusion criteria, this review is not registered.
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http://dx.doi.org/10.1186/s12913-018-3775-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421946PMC
December 2018

A voice for the patients: Evaluation of the implementation of a strategic organizational committee for patient engagement in mental health.

PLoS One 2018 24;13(10):e0205173. Epub 2018 Oct 24.

Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada.

Objective: There is a need for structure to achieve functional patient engagement within mental healthcare organizations, and for clarification on how to proceed on a strategic level. The aim of this paper is to shed light on the implementation of a strategic organizational structure for patient engagement in mental health by examining why and how to implement a structure, the organizational and environmental factors that facilitate or limit the process, and the perceived consequences of the implementation.

Method: This paper evaluates the implementation of a strategic committee for patient engagement in a mental healthcare organization in Montreal (Quebec, Canada). The research was designed as a qualitative single case study using a deductive approach by means of a conceptual framework. Data sources consisted in ten semi-structured interviews, three focus groups, and organizational documents.

Results: The strategic committee for patient engagement was implemented as a means to formalize patient partner participation, following the introduction of a vision of full citizenship. Important aspects of its implementation included its composition and role, the elaboration of a framework for patient partner participation, and finally, ongoing application and evaluation of the framework. Several facilitating factors were identified, including executive management support, leadership, and a vision behind the participation. Limiting factors mainly consisted of resistance towards patient participation and the existence of stigma. Consequences included increased and improved patient engagement, as well as reduced stigma within the organization.

Conclusion: This study shows that the implementation of a strategic organizational structure for patient engagement is comprehensive. It further shows the importance of a vision and an articulate leadership involving several actors. Further research is needed regarding the impact of this type of strategic structure on a clinical level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205173PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200221PMC
April 2019

A Therapeutic Educational Program in Oral Health for Persons with Schizophrenia: A Qualitative Feasibility Study.

Int J Dent 2018 24;2018:6403063. Epub 2018 Sep 24.

Clinical Research Unit, La Chartreuse Psychiatric Centre, 21033 Dijon, France.

Objective: The aim of this study was to test the feasibility of a therapeutic educational program in oral health (TEPOH) for persons with schizophrenia (PWS).

Design: In a qualitative study, we explored the representation of oral health before and after a TEPOH. : PWS are at greater risk of decayed and missing teeth and periodontal diseases. In a previous publication, we described the different steps in building a TEPOH by taking into account the experiences of PWS concerning oral health quality of life. This TEPOH aimed at promoting a global health approach. : Voluntary PWS and their caregivers were recruited during face-to-face interviews at "Les Boisseaux" (a psychiatric outpatient centre) in Auxerre (France) and were included in the study between November and December 2016. : We explored the experiences of participants and their perceptions of oral health before and after the TEPOH with focus group meetings.

Results: Four females and three males participated in the study, and the mean age was 29.4 ± 5. Before the TEPOH, the PWS produced 28 ideas about oral health perception and 37 after the TEPOH. After the TEPOH, elements relating to the determinants of oral health (smoking and poor diet) emerged.

Conclusions: These results show an evolution in oral health representation, and after some adjustments to the TEPOH, the second step will be to test this program in a large sample to generate a high level of evidence of the impact of TEPOH in the long term.
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http://dx.doi.org/10.1155/2018/6403063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174768PMC
September 2018

[Including recovery in the care pathway after cancer].

Soins 2018 Apr;63(824):66-68

Département de psychiatrie, Université de Montréal, pavillon Roger-Gaudry 2900, boul. Édouard-Montpetit, bureau S-750, Montréal H3T 1J4, Québec.

The period after cancer treatments have finished requires personalised services and support, based on the theoretical and clinical concept of recovery. The recovery phase comprises several dimensions: it is not because a patient is in remission or declared medically cured that he or she has recovered.
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http://dx.doi.org/10.1016/j.soin.2018.02.016DOI Listing
April 2018

Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial.

Schizophr Res 2018 07 24;197:176-181. Epub 2018 Feb 24.

Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Canada; Institut Philippe-Pinel de Montréal, Montreal, Canada. Electronic address:

Schizophrenia is a chronic and severe mental illness that poses significant challenges. While many pharmacological and psychosocial interventions are available, many treatment-resistant schizophrenia patients continue to suffer from persistent psychotic symptoms, notably auditory verbal hallucinations (AVH), which are highly disabling. This unmet clinical need requires new innovative treatment options. Recently, a psychological therapy using computerized technology has shown large therapeutic effects on AVH severity by enabling patients to engage in a dialogue with a computerized representation of their voices. These very promising results have been extended by our team using immersive virtual reality (VR). Our study was a 7-week phase-II, randomized, partial cross-over trial. Nineteen schizophrenia patients with refractory AVH were recruited and randomly allocated to either VR-assisted therapy (VRT) or treatment-as-usual (TAU). The group allocated to TAU consisted of antipsychotic treatment and usual meetings with clinicians. The TAU group then received a delayed 7weeks of VRT. A follow-up was ensured 3months after the last VRT therapy session. Changes in psychiatric symptoms, before and after TAU or VRT, were assessed using a linear mixed-effects model. Our findings showed that VRT produced significant improvements in AVH severity, depressive symptoms and quality of life that lasted at the 3-month follow-up period. Consistent with previous research, our results suggest that VRT might be efficacious in reducing AVH related distress. The therapeutic effects of VRT on the distress associated with the voices were particularly prominent (d=1.2). VRT is a highly novel and promising intervention for refractory AVH in schizophrenia.
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http://dx.doi.org/10.1016/j.schres.2018.02.031DOI Listing
July 2018

Effects of concentrated long-chain omega-3 polyunsaturated fatty acid supplementation before radical prostatectomy on prostate cancer proliferation, inflammation, and quality of life: study protocol for a phase IIb, randomized, double-blind, placebo-controlled trial.

BMC Cancer 2018 01 10;18(1):64. Epub 2018 Jan 10.

Oncology Unit, Centre de recherche du CHU de Québec - Université Laval - L'Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC, Canada.

Background: Prostate cancer is the most commonly diagnosed cancer in north-American men. Few dietary or lifestyle interventions have been tested to prevent prostate cancer progression. Omega-3 fatty acid supplementation represents a promising intervention for prostate cancer patients. The aim of the study is to evaluate the effects of long-chain omega-3 polyunsaturated fatty acids (LCn3), more precisely eicosapentaenoic acid monoacylglyceride (MAG-EPA) supplementation, on prostate cancer proliferation, inflammation mediators and quality of life among men who will undergo radical prostatectomy.

Methods/design: We propose a phase IIb, randomized, double-blind placebo-controlled trial of MAG-EPA supplementation for 130 men who will undergo radical prostatectomy as treatment for a prostate cancer of Gleason score ≥ 7 in an academic cancer center in Quebec City. Participants will be randomized to 6 capsules of 625 mg of fish oil (MAG-EPA) per capsule containing 500 mg of EPA daily or to identically looking capsules of high oleic acid sunflower oil (HOSO) as placebo. The intervention begins 4 to 10 weeks prior to radical prostatectomy (baseline) and continues for one year after surgery. The primary endpoint is the proliferative index (Ki-67) measured in prostate cancer cells at radical prostatectomy. A secondary endpoint includes prostate tissue levels of inflammatory mediators (cytokines and proteins) at time of radical prostatectomy. Changes in blood levels of inflammatory mediators, relative to baseline levels, at time of radical prostatectomy and 12 months after radical prostatectomy will also be evaluated. Secondary endpoints also include important aspects of psychosocial functioning and quality of life such as depression, anxiety, sleep disturbances, fatigue, cognitive complaints and prostate cancer-specific quality of life domains. The changes in these outcomes, relative to baseline levels, will be evaluated at 3, 6, 9 and 12 months after radical prostatectomy.

Discussion: The results from this trial will provide crucial information to clarify the role of omega-3 supplementation on prostate cancer proliferation, inflammation and quality of life.

Trial Registration: ClinicalTrials.gov Identifier: NCT02333435. Registered on December 17, 2014. Last updated September 6, 2016.
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http://dx.doi.org/10.1186/s12885-017-3979-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763552PMC
January 2018

Organizational participatory research: a systematic mixed studies review exposing its extra benefits and the key factors associated with them.

Implement Sci 2017 10 10;12(1):119. Epub 2017 Oct 10.

Special Projects, Canadian Pharmacists Association, 1785 Alta Vista Drive, Ottawa, ON, K1G 3Y6, Canada.

Background: In health, organizational participatory research (OPR) refers to health organization members participating in research decisions, with university researchers, throughout a study. This non-academic partner contribution to the research may take the form of consultation or co-construction. A drawback of OPR is that it requires more time from all those involved, compared to non-participatory research approaches; thus, understanding the added value of OPR, if any, is important. Thus, we sought to assess whether the OPR approach leads to benefits beyond what could be achieved through traditional research.

Methods: We identified, selected, and appraised OPR health literature, and at each stage, two team members independently reviewed and coded the literature. We used quantitative content analysis to transform textual data into reliable numerical codes and conducted a logistic regression to test the hypothesis that a co-construction type OPR study yields extra benefits with a greater likelihood than consultation-type OPR studies.

Results: From 8873 abstracts and 992 full text papers, we distilled a sample of 107 OPR studies. We found no difference between the type of organization members' participation and the likelihood of exhibiting an extra benefit. However, the likelihood of an OPR study exhibiting at least one extra benefit is quadrupled when the impetus for the study comes from the organization, rather than the university researcher(s), or the organization and the university researcher(s) together (OR = 4.11, CI = 1.12-14.01). We also defined five types of extra benefits.

Conclusions: This review describes the types of extra benefits OPR can yield and suggests these benefits may occur if the organization initiates the OPR. Further, this review exposes a need for OPR authors to more clearly describe the type of non-academic partner participation in key research decisions throughout the study. Detailed descriptions will benefit others conducting OPR and allow for a re-examination of the relationship between participation and extra benefits in future reviews.
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http://dx.doi.org/10.1186/s13012-017-0648-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634842PMC
October 2017

[The Global Model of Public Mental Health and Recovery Mentors].

Sante Ment Que Spring 2017;42(1):223-241

Table de quartier Solidarité Mercier-Est.

Objectives The aim of this paper is to revisit the Global Model of Public Mental Health (GMPMH) in light of the 4th Civic Forum. Recovery mentors of the University of Recovery chaired this public event, which was held in East-end Montreal, Canada, in 2016. The University of Recovery is a concept of co-learning among its members.Methods Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in public health and health promotion programs, while adding to that approach the recovery mentors, as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented practices through the Ottawa Charter for Health Promotion of the World Health Organization. Indeed, here the GMPMH is said to be global in that the supranational and individual levels reinforce each other, taking turns with a) a set of legal rules and international conventions on human rights, including those of disabled persons, and b) the active involvement and agency of recovery mentors who can evoke these rules and conventions as part of a plea for the recognition of their personal and collective capacity for change; they acted as tracers of recovery trajectories during the Civic Forum. The GMPMH was first published in 2009, and revisited in 2013. While this latter revision was based on the 3rd Civic Forum, in this paper we use the same approach to revisit the GMPMH as underpinned by the findings and recommendations of the 4th Civic Forum, which discussed questions related to work and employment.Results Updating the GMPMH in light of the Civic Forum underlines the need for a more inclusive type of governance regarding policy and systems transformation. Local communities and persons in recovery can reach each other to promote change and capacity building, for instance through quality assessment, and evaluation of human rights' level of respect in healthcare facilities and more broadly. People with mental health challenges ought to be "included in the community" - as this is a right, not a reward (UN Convention on the Rights of Persons with Disabilities, art. 19). This is achievable if the community is informed and welcoming, for instance in getting involved with a Civic Forum and its organizing committee. The degree to which a transformational agenda is participatory is revealed as a predictor of the degree to which the broader community can be reflexive about its own inclusiveness for a genuinely global approach of public mental health, and with a cascading emulation effect.Conclusion Transition from social marginalization to full citizenship represents a daunting challenge in public mental healthcare. Creating access to the valued roles which individuals will be able to occupy in community and workplace settings requires capacity building and inter-sectorial synchronicity, as suggested by recovery mentors who can act as tracers to reveal obstacles and gateways in the recovery journey. Public intervention and debate are required to promote and monitor the bond of citizenship that connects people to their communities, and the quality of this bond needs to be included in the scope of public mental health for continuity and equity of access.
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November 2017

[Evaluation of a citizenship-oriented intervention: The Citizens' Project of the University of Recovery].

Sante Ment Que Spring 2017;42(1):205-222

Yale School of Medicine/Program for Recovery & Community Health.

Objectives The Global Model of Public Mental Health is "global" not only in the sense of having an international perspective, but in regarding service users as actors at all levels of public mental health exerting collective and organized influence on the social determinants of health, in addition to being recipients of care. Having access to appropriate health and mental health care when needed is a fundamental human right. Having a say over the manner in which care is provided, including partnership in decision making in care planning and ongoing care, has gained increasing support among recipients and providers of care. Over the past few decades in the Canadian province of Quebec, patient participation and partnership in decision-making has been promoted through successive Mental Health Action Plans (MHAP) and other policies. In these documents, participation and partnership are associated with the exercise of citizenship and the promotion of service users' rights, including the rights to participate in one's own care. In this article, using the case example of a citizenship-oriented intervention, namely the Projet citoyen, we discuss the results to a new measure of citizenship, which was developed from a service users' perspective.Methods Employing a mixed methods approach, two types of data were collected from users of mental health care. Quantitative data were generated from administration of a 23-item measure of citizenship with service users in the province of Quebec (N=802), and qualitative data were collected from four focus groups with another sample of 18 service users. They were presented with results from the administration of the measure, and asked to comment on them in regard to their own experience of citizenship.Results Among the five dimensions of the measure of citizenship, participants scored lowest on the 'involvement in the community' dimension, and higher on the other dimensions of 'basic needs,' 'respect by others,' 'self-determination,' and 'access to services.' In focus groups, participants said that there is still prejudice in society and discrimination towards people with mental illnesses that limit their right to participate in public debate and mental health programming. Public health interventions at this level may help to change attitudes and social representations, as they are inclusive of persons with lived experience of mental illness. Public discussion of citizenship issues in relation to mental health also represent an opportunity for participants to confront existing problems, as a first step toward collective action.Conclusion People's lived experience of regaining a sense of citizenship and of belonging to their local neighborhoods and communities, including the scientific micro-community, can help to foster an evolution of public health from disease management to health promotion and community inclusion. More research is needed to compare the sense of citizenship to the rest of the population and to see if specific interventions can have an enduring impact (e.g.: pre/post design).
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November 2017

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) » in a French representative sample of patients with schizophrenia.

BMC Oral Health 2017 Apr 11;17(1):75. Epub 2017 Apr 11.

EA 481 Integrative Neurosciences and Clinical, University Hospital of Besançon, F-25000, Besançon, France.

Background: The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia.

Methods: A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects.

Results: The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05).

Conclusion: Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients.

Trial Registration: Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.
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http://dx.doi.org/10.1186/s12903-017-0368-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387256PMC
April 2017

[On the University of Recovery].

Sante Ment Que Spring 2016;41(1):241-50

Programme international de recherche action participative/Centre de recherche de l'Institut universitaire en santé mentale de Montréal.

Objectives Located at the heart of a mental health university institute in Montreal, Canada, the University of Recovery (UR) is a peer-run agency of service users who came together as a private non-profit organization to promote their experiential knowledge in science and public health, and to transform the academic milieu as an inclusive work environment conducive to recovery and full citizenship. UR students can thus have access to scientific conferences and classes on various topics and invite scientists or other professionals to further discuss new discoveries and techniques, and possible ways of improving healthcare from a patients' and service users' perspective. Our conversation with a scientist specialized in obsessive-compulsive disorders triggered this collective reflection on neuroimaging in terms of psychiatric diagnoses, prognoses, recovery opportunities and meta-cognition.Method At the core of the UR as a therapeutic education program is the Projet Citoyen, an adaptation and a transposition in Montreal of the Yale Citizens Project, which has been developed in New Haven, USA, over the past fifteen years. The Projet Citoyen is comprised of four main components: bi-weekly group discussions, individualized peer support, involvement and practicum in the community, and participation in public events and debates. UR students therefore evolve in the academic and scientific milieu, here regarded as a translational community and human laboratory towards social inclusion and full citizenship. UR students can be involved as auxiliaries of medical training to always promote and illustrate recovery opportunities when psychiatric 'dysfunctions' or 'disorders' are the topics of a medical class. In April 2016, UR students invited Dr Marc Lavoie to discuss is work on obsessive-compulsive disorders (OCD). The content of this group discussion is herein reported.Results UR students learned, among other things, that neuroimaging can be used to identify patterns of brain reactions to various stimuli and situations, reactions that can be different from one psychiatric condition to another and to the rest of the 'normal' population. For example, bright red, green, or blue shades of color can show an over-activation of the thalamus for persons with OCD. This difference can be indicative of a so-called cognitive impairment, with some people reacting more 'emotionally' to an image than other persons for whom the reaction would imply parts of the brain which are normally rather associated to 'rational' thinking (e.g.: the cerebral cortex). Such a difference, when it appears through a neuroimaging technique like EEG or MRI, does not lead to the enunciation of a particular diagnosis for an individual, but can give some complementary indications to be used in conjunction with other observations and can inform the choice for a therapeutic approach. Cognitive Behavioural Therapy, for instance, has been statistically shown to be associated with anatomic changes in the human brain. Through some quite spectacular images of parts and subparts of the brain in action, UR students were able to admire all this beautiful neurodiversity. Then we discussed the concept of neuroplasticity: we now know that many aspects of the brain remain changeable or "plastic" even into adulthood, which contrasts with the previous common consensus that the human brain develops during childhood, then remains at once unchangeable afterward and "static."Conclusion Diverse neurological conditions appear as a result of normal variations in the human genome and in affect, the concepts of neurodiversity and of neuroplasticity go much beyond the prevailing prior conceptual conditioning of neurological differences as being inherently pathological and an irreversible "error of Mother Nature." There may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli, and a psychotherapy could then consist of recognizing this conditioning and learning how to think and react differently to a triggering stimulus. The University of Recovery is thus first and foremost a principle of mutuality among its members - the students in recovery - who are allied through self-help as a basis for metacognitive therapeutic education.
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January 2017

Use of a mobile device in mental health rehabilitation: A clinical and comprehensive analysis of 11 cases.

Neuropsychol Rehabil 2018 Jul 17;28(5):832-863. Epub 2015 Nov 17.

a School of Rehabilitation , University of Montreal , Montreal , Quebec.

This study aimed to test the feasibility of using a mobile device (Apple technology: iPodTouch®, iPhone® or iPad®) among people with severe mental illness (SMI) in a rehabilitation and recovery process and to document the parameters to be taken into account and the issues involved in implementing this technology in living environments and mental health care settings. A qualitative multiple case study design and multiple data sources were used to understand each case in depth. A clinical and comprehensive analysis of 11 cases was conducted with exploratory and descriptive aims (and the beginnings of explanation building). The multiple-case analysis brought out four typical profiles to illustrate the extent of integration of a personal digital assistant (PDA) as a tool to support mental health rehabilitation and recovery. Each profile highlights four categories of variables identified as determining factors in this process: (1) state of health and related difficulties (cognitive or functional); (2) relationship between comfort level with technology, motivation and personal effort deployed; (3) relationship between support required and support received; and (4) the living environment and follow-up context. This study allowed us to consider the contexts and conditions to be put in place for the successful integration of mobile technology in a mental health rehabilitation and recovery process.
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http://dx.doi.org/10.1080/09602011.2015.1106954DOI Listing
July 2018

[A Grand Lady and two self-made men: testimony of a patient-investigator].

Sante Ment Que 2015 ;40(1):267-74

The psychological distress of a person, a parent in this case, can have very significant impact on family dynamics and the fate of all family members. They may become unwitting experts of mental health, by accompanying necessity and with their own vulnerabilities, sometimes trying to understand misunderstanding. This story is that of a patient-investigator who questioned the impact that mental illness has had on his professional life and his career choices. Going back to distant childhood memories, this exercise has proved to be an introspective work or observation of an individual conscience by itself. The fruit of this reflection is the story of a double conversion, spiritual and scientific, and this attempt to find sense and meaning to this personal journey becomes a socially engaged ethics of research in mental health and psychiatry.
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October 2015

[The patient-user-citizen revolution continues].

Sante Ment Que 2015 ;40(1):11-7

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October 2015

Feasibility and acceptability of patient partnership to improve access to primary care for the physical health of patients with severe mental illnesses: an interactive guide.

Int J Equity Health 2015 Sep 14;14:78. Epub 2015 Sep 14.

School of Medicine, The University of Queensland, Brisbane, Australia.

Introduction: Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses.

Methods: A participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition.

Results: Patient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners.

Conclusion: This research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.
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http://dx.doi.org/10.1186/s12939-015-0200-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568580PMC
September 2015

[Issues, dilemmas and managerial strategies of potential ethical risks associated with the implementation of patient partnership practices in psychiatry: a case study].

Sante Ment Que 2015 ;40(1):119-34

Département de psychiatrie, Université de Montréal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal; Department of Psychiatry, Yale University.

Objective: In terms of health and social services, the territory of the province of Quebec is covered by four large 'integrated university health networks,' which are involved in the coordination of care delivery and medical training. The francophone components of the public mental health system for Montreal are thus primarily linked to the Integrated University Health Network of University of Montreal. In 2010, the Faculty of Medicine of the University of Montreal has included in its development strategy a firm commitment to the development and implementation of the 'patient partner expertise' in research, training and care in order to make this expertise no less than the brand of the Faculty. This commitment applies to all medical specialties that are taught at University of Montreal, including in psychiatry. More recently, the Institut universitaire en santé mentale de Montréal (IUSMM) has endorsed a new clinical vision that promotes full citizenship, which implies that service users and carers are considered as full partners with a specific expertise to be fully deployed. The objective of this paper is to examine, from an ethical point of view, the challenges that may be associated with involving such lay persons in various levels of mental health care planning and delivery, and in research.

Methods: This study is mainly based on a review of the institutional processes that are in place at the IUSMM to promote service users' participation in care planning and delivery, and in research. The focus is on the practicalities and conditions for the exercise of such an active participation, as some questions and concerns emerged through a series of interviews with different stakeholders. These issues are addressed and discussed through the lenses of the ethical values that were formalized at IUSMM.

Results: Despite a firm institutional commitment at IUSMM to implement its new citizenship-oriented clinical vision through greater service users' involvement, little is known about the possible negative impacts of their participation, on themselves and for regular employees. There is a consensus on the symbolic value of recognizing the potential of service users as contributors, as a peer workers or peer research assistants. This is an historic advance compared to a time when they were considered only as more or less passive recipients of services or as a simple research subjects. Some risk factors were nonetheless identified: isolation, emotional fatigue, possible relapse, insecurity, sometimes tensed relations with health or research professionals and misunderstanding. In organizational terms, among the pitfalls, the study highlighted the need for more cautious preparatory steps, guidance and support for service users and for professionals as well, and the importance of a global and integrated governance strategy.

Conclusion: This study points to three main recommendations to better anticipate and manage possible risks associated with more or less improvised service users' active participation, as lay persons, in complex planning and service delivery and in research. The first would be directed towards professionals for them to reflect on the quality of the doctor-patient relationship in their facility as to see how service users can help to improve this relationship, but among a variety of stakeholders and without being the sole responsible for such an improvement, or for the lack of improvement thereof. The second recommendation would propose to draw an objective evaluative assessment of participatory approaches at the organizational level, promoting a real return of experience and in light of the issues raised by these practices. The third would recommend an update of the organizational ethical values when introducing practices that change the current paradigms of the provision of care and services and of research.
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October 2015

[At the very roots of psychiatry as a new medical specialty: the Pinel-Pussin partnership].

Sante Ment Que 2015 ;40(1):19-33

Department of Psychiatry, Yale University, New Haven.

Objectives: Moral treatment is a psychological approach that contrasted sharply with a treatment of constraint, beatings, immersion in cold water, diet, or repeated heavy bleeding. In response to the violent treatment that was common in asylums of late 18th century, Philippe Pinel conceived a 'medical moral treatment'. This paper considers the roots of the recovery paradigm in the pioneering work of Philippe Pinel and Jean-Baptiste Pussin. The aim is to discuss the early 19th century moral treatment to identify some key principles that can also inspire citizenship-oriented mental health care, but we also suggest that a simple equating of citizenship-oriented practice with moral treatment overlooks some of the central aspects of the recovery paradigm.

Methods: One of the main sources for this discussion is Pinel's 'Memoir on madness' (Pinel, 1794), offered for the first time to the English-speaking reader by Dora Weiner. This analysis also draws on the 'Observations of Citizen Pussin' that Pinel asked him to write for both of them to articulate fully several of the key principles of their humanistic approach.

Results: Looking back on the humanistic principles that were at the core of the pioneering work of Philippe Pinel and Jean-Baptiste Pussin, we suggest that the 'moral treatment' they were advocating, more than 200 years ago, was in some ways based on a genuine patient partnership, especially on peer support. The contemporary recovery movement, that might also be centered on the full exercise of citizenship, and the older 'moral treatment' have in common that they both insist that people with mental illness be treated with dignity and respect. However, while the 'moral treatment' was taking place within the asylum, the goal of citizenship-oriented mental health care is one of a life in the community for everyone. We suggest, nevertheless, that Pinel and Pussin have formulated ideas probably so forward thinking that we are just beginning to understand and try to apply them to our post-asylum practices.

Conclusion: Pinel's philosophy of psychiatry both undergirded moral treatment and can be useful in shaping contemporary patient-centered and citizenship-oriented practice. The insights and lessons offered by Pinel and Pussin are far from being limited to the place and time of their creation. Recent advances in mental health care have been based on insights identical to those of Pinel and Pussin regarding the episodic nature of the illness, the rarity of the illness becoming all-encompassing, the reality of recovery, and the valuable roles that employment and peer mentoring can play in promoting it. We have now seen in the two hundred years that followed the publication of Pinel's Treatise the failures of asylums to provide moral treatment to persons with mental illnesse. In contrast, citizenship-oriented care stresses the importance of self-determination and the active role of the person in recovering a sense of efficacy and agency as a foundation for full citizenship for all.
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October 2015

Citizenship and recovery: two intertwined concepts for civic-recovery.

BMC Psychiatry 2015 Mar 4;15:37. Epub 2015 Mar 4.

Department of Psychiatry, Yale School of Medicine, New Haven, USA.

Background: Validation of the psychometric properties of a new measure of citizenship was required for a research project in the province of Quebec, Canada. This study was meant to study the interplay between recovery- and citizenship-oriented supportive employment. As recovery and citizenship were expected to be two related concepts, convergent validity between the Citizenship Measure (CM) and the Recovery Assessment Scale (RAS) was tested.

Methods: Study objectives were to: 1) conduct exploratory factor analyses on the CM and confirmatory factor analysis on the RAS tools (construct validity), 2) calculate Cronbach's alphas for each dimension emerging from objective 1 (reliability), and 3) calculate correlations between all dimensions from both tools (convergent validity). Data were collected from 174 individuals with serious mental illness, working in social firms. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder.

Results: Five factors emerged from the exploratory factor analysis of the CM, with good reliability. Confirmatory factor analyses showed that the short and the long versions of the RAS present satisfactory results. Finally, the correlation matrix indicated that all dimensions from both tools are significantly correlated, thus confirming their convergent validity.

Conclusions: This study confirms the validity and reliability of two tools, CM and RAS. These tools can be used in combination to assess citizenship and recovery, both of which may be combined in the new concept of civic-recovery.
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http://dx.doi.org/10.1186/s12888-015-0420-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355550PMC
March 2015

Akt confers cisplatin chemoresistance in human gynecological carcinoma cells by modulating PPM1D stability.

Mol Carcinog 2015 Nov 23;54(11):1301-14. Epub 2014 Aug 23.

Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Ovarian cancer (OVCA) and cervical cancer (CECA) are lethal gynecological malignancies. Cisplatin (CDDP) and platinum derivatives are first line chemotherapeutics and their resistance impedes successful treatment. Understanding the molecular dysregulation underlying chemoresistance is important in developing rational therapeutic strategies. We have established that Protein Phosphatase Magnesium-dependent 1 D (PPM1D) confers CDDP resistance in gynecological cancer cells by deactivating p53. However, whether CDDP regulates intra-cellular PPM1D localization and whether this regulation is different between chemosensitive and chemoresistant cancer cells is unknown. Moreover, whether Akt regulates PPM1D in the context of CDDP resistance has not been studied. To illustrate the role of PPM1D in gynecological cancer cell chemoresistance and its regulation by Akt we have demonstrated that: (a) CDDP induced PPM1D down-regulation through proteasomal degradation in sensitive CECA cells; (b) CDDP induced PPM1D nuclear localization in resistant CECA cells, and nuclear exclusion in sensitive CECA cells and OVCA xenografts; (c) Over-expression of active Akt in sensitive CECA cells stabilized PPM1D content through inhibition of CDDP-induced PPM1D down-regulation; (d) Inhibition of Akt activity in resistant OVCA cells leads to decreased PPM1D stability and CDDP-induced down-regulation in resistant CECA cells; and (e) PPM1D is highly expressed in human ovarian tumor subtypes and in a tissue microarray panel of human ovarian tumors. In conclusion, we have established that PPM1D plays an important role in promoting CDDP resistance and as a novel downstream target of Akt, PPM1D mediates its action in conferring CDDP resistance in gynecological cancer cells.
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http://dx.doi.org/10.1002/mc.22205DOI Listing
November 2015

[For us, being full citizens means…].

Sante Ment Que 2014 ;39(1):311-24

Centre de recherche de l'Institut universitaire en santé mentale de Montréal.

Objective: One of the four main chapters of the consultation document proposed by the Québec Ministère de la santé et des services sociaux (Health and Social Services), in preparation for the National Forum on the Mental Health Action Plan 2014-2020, is dedicated to the full exercise of citizenship. This paper reports the dialogue that took place between the CEO of a university mental health institute and a group of service users, in order to participate in the consultation process regarding the full exercise of citizenship.

Method: Since May 2013, a dozen service users have gathered in the Projet citoyen at the Research Centre of Institut universitaire en santé mentale de Montréal (IUSMM). The Projet citoyen is a culturally adapted transposition, in Québec, of the Citizens Project that is in place in New Haven, Connecticut. One of the key components of both the Projet citoyen and the Citizens Project interventions is a group training regarding citizenship. Participants discuss what it means for them to be full citizens and they support each other in achieving personal or collective goals. To assess progress made in such matters, a new Citizenship Measurement has been developed by the Yale Program for Recovery & Community Health, and translated into French. This Mesure de la citoyenneté is in the process of being validated; peer research assistants conducted data collection by asking 178 people who use the mental health services of Quebec to complete the French Mesure de la citoyenneté. The preliminary results of a statistical analysis were used to structure the dialogue between the IUSMM CEO and the participants of the Projet citoyen.

Results: Three sub-scales emerged from preliminary statistical analysis (clusters). Colleagues of the Projet citoyen were invited, through a focus group conducted by one of them, to give evocative labels to these sub-scales. Regarding the first one, we felt that it was about asking ourselves what we can bring to others' lives, wondering how we, as members of the community, can make a difference for a more inclusive civic cohabitation. The label "contribution to the community" was chosen. For the second sub-scale, personal and social spheres emerged as both being essential to the achievement of full citizenship. These spheres must be respected in complementarity. Hence we chose the label: "personal and social integrity." Finally, the third sub-scale seemed to combine items that have the common elements of respecting human rights, respecting the person, and respecting the autonomy of the person. "Rights and freedom of choice" was chosen as a label for that sub-set. The IUSMM CEO immersed herself in the Projet citoyen and as her dialogue with the participants deepened around these features, a sense of mutual respect and friendliness got stronger. Participants were pleasantly surprised to see that an influential CEO can be sensitive and comfortable expressing this sensitivity, even with her emotions while interacting with service users as they are exercising their own citizenship as research colleagues.

Conclusion: This case study illustrates a way of triangulating qualitative and quantitative data sets generated from a participatory-action research project for which people who use mental health services have been active research partners throughout. A mobilizing effect was found among participants of the Projet citoyen who become multipliers once back in their respective communities and neighborhoods. This effect can also affect a senior manager. The ISUMM CEO was inspired to relay and communicate this innovative thinking on the full exercise of citizenship as a governmental priority in mental health. It could thus be recommended to implement and network some Projets citoyens in other educational, research and clinical settings. This would provide opportunities for service users to contribute to the community - here, the scientific community. It would exemplify respect for personal and social integrity by channeling the expression of the lived experience into an instrument of change. These Projets citoyens would advocate for the rights and freedom of choice of service users as partners, in action, of a citizenship-oriented mental health system.
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October 2014

[Public participation and civic participation of service users in relation to the Mental Health Action Plan 2005-2010: their spokesperson function].

Sante Ment Que 2014 ;39(1):175-93

École de service social, Université de Montréal; Alliance internationale de recherche universités-communautés Santé mentale et citoyenneté

Context: Among the guiding principles of the Mental Health Action Plan 2005-2010 (MHAP) of the Quebec Ministère de la santé et des services sociaux (Health and Social Services) is the recognition that persons who use mental health services (consumers) can be active agents of their own individual and collective recovery journey. In accordance with this principle, the MHAP called for greater participation of consumers in local, regional and national decision-making bodies within the network of health and social services in Quebec.

Objective: The objectives of this article are to look back on the various forms of consumers' participation in connection with the MHAP since its enactment, and to better understand the complexities of being spokespersons through the Actor Network Theory conceptual framework.

Method: A scientific literature review was conducted. Different angles of analysis were used to highlight convergences and trends based on official governmental publications and ongoing research on consumers' participation in decision and policy making. It was thought that a vertical case study approach would offer an historical perspective going back to the early 1960s to discuss the foundations of an "ideology of participation." Another way of assessing participation is through a horizontal approach that would compare the terms of participation implemented from one regional authority to the other, in order to cover most of the Quebec territory.

Results: The MHAP did not provide clear indicators of how to assess progress made with regards to greater consumer participation. In some regions of Quebec, this participation was coordinated by community organizations that designated their representatives. In other regions, local authorities included consumers on a more individual basis to give their opinion. As all were not at the same stage in their recovery process, some were in a position to speak using the "we," while others still needed to express themselves using the "I." In either case, their function as spokespersons proved to be a bi-directional function. In one direction, the spokesperson informed the governmental and institutional stakeholders about the expectations of consumers and about their daily life realities. In the other way, they were able to explain and make more intelligible the intricacies of the system with a lay language, which helped non specialists they encountered to remain informed partners, even though indirectly. As they shared their experience as spokespersons with their peers, their peers were able to get a clearer understanding of the progress made to effectively promote active and effective participation. The lack of clear expectations and dedicated means to support participation, induced discrepancies from one region to another, making it difficult, though, to assess progress made overall.

Conclusion: As the function of spokesperson got more professionalized with increased opportunities to participate in policy and decision-making, spokespersons spoke from an "us" rather than an "I" standpoint. The concept of public participation evolved to one of civic participation, with the possibility to transcend the "us" and "them" dichotomy, as members of a community are all citizens to one another. Still, the terms and conditions of participation could be better defined and more predictable for greater equity in terms of access to different levels of policy and decision-making.
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October 2014

Clinical characteristics and service use of incarcerated males with severe mental disorders: a comparative case-control study with patients found not criminally responsible.

Issues Ment Health Nurs 2014 Aug;35(8):597-603

Institut Philippe-Pinel de Montréal, Montréal, Quebec, Canada.

Since the drop in the bed capacity of civil psychiatric hospitals, an increase in the bed capacity of forensic psychiatric care and prison units has been reported in the United States and Europe. However, in Canada, a decrease in the number of people with severe mental illness (SMI) during the last two decades in penitentiaries has been reported. At the same time, an increase in individuals found not criminally responsible on account of mental disorder (NCRMD) was observed in forensic hospitals. The aim of this study is to compare incarcerated severely mentally ill (I-SMI) individuals with forensic-hospitalized SMI individuals in terms of their clinical profiles and service use in the province of Quebec (Canada). A case-control study design was selected using a sample of 44 I-SMI individuals and 59 forensic-hospitalized SMI individuals. Important findings include the following: I-SMI persons had less schooling; they more often reported suicide attempts and violent and non-violent crimes; and they had a higher level of comorbidity involving Cluster B personality disorders and substance-use disorders. Forensic-hospitalized SMI persons were more likely to have been receiving psychiatric follow-up before hospitalization. The final logistic regression model showed that lifetime suicide attempts, non-violent crimes, and psychopathic traits were higher among I-SMI individuals than among forensic-hospitalized SMI individuals. In contrast, receiving regular psychiatric follow-up was associated with forensic-hospitalized SMI individuals. Differences in psychopathological characteristics and the use of mental health services were found for I-SMI persons. More research is needed to determine which new initiatives might be efficacious in addressing the mental health needs of I-SMI individuals.
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http://dx.doi.org/10.3109/01612840.2013.861885DOI Listing
August 2014
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